One of the most difficult subdivisions of plastic surgery is deviated nose rhinoplasty. In order to better understand this topic, I would like to further explain the meaning of deviation and the anatomy of the nose generally.
All nasal elements are placed as a pair. Right and left and they are separated by a wall in the middle which is named the septum. On the frontal view, in the upper part septum is placed between two nasal bone and in the lower part of the nose, it is placed between lateral cartilages as if the upper part is made out of bone and the lower part is made out of cartilages. In the internal space of the nose, this septum has separated nasal cavity into two spaces as a wall. The caudal part of the septum is settled just behind the septum while in the floor, the septum has attached to a hard palate and in the roof it has attached to the skull base. Easily we could imagine the septum and the nasal cavity as paired tunnel which have been separated by septum. The function of these pairs is to transport air from the nostril to the nasopharynx. Now following this explanation I will further speak about the effect of septal deviation on the anatomy of the nose. Whenever this septum is strayed from midline we call it septal deviation. This deviation affects other parts of the nose which will be explained later.
#1. One of the most common positions of the deviation is situated in the floor of the nose where the septum is attached to the hard palate and it causes narrowing of air passage in the same side. Sometimes this deviation is symptomatic and causes nasal blockage.
#2. Deviation of the caudal part of the septum just behind columella which affects the shape of the nostril and sometimes is symptomatic.
#3. Deviation in the dorsal part of septum which is apparent in the frontal view, the septum thickness is about 1-2 millimeters and situated between nasal bones and lateral cartilages. So it is crystal clear that any deviation in this part causes deviation in nasal bone and cartilages as well. In which results to asymmetry of the nose. Most of the deviation is due to one of the reasons above. Most patients are complaining about nasal blockage and nasal deviation. In order to treat nasal blockage the surgeon will remove the septum that is protruded into the nasal cavity. The significant challenge is the visible appearance of the deviation however a surgeon must apply various techniques to overcome this issue.
Surgical treatment of deviated nose
Before mentioning techniques it is better to talk about the development of the nose during childhood. There are some paired centers for nasal growth which are named growth’s centers. They are in charge of the nasal development. If any trauma occurs during childhood the fractured line might have passed through those centers and cause halting the nose development. So one side of the nose keeps growing while the opposing side does not. It will result in asymmetry in terms of the nose shape. Therefore the issue is not only the septum but also all the other supporting elements are compromised as well. The surgeon should not only straighten the septum but also must make both sides symmetrical. This asymmetry in both bones and cartilages is pseudo deviation opposing to septum which is a true deviation.
For correcting the septum we could apply spreader graft or suturing techniques and or correcting of bony part of septum we could use different time of osteotomies which they are out of the scope of this article. In order to make the nose more symmetrical we apply different types of grafting.
Although we do our best to make the nose completely symmetrical especially in thin-skinned nose there is a chance of minor asymmetry which could be seen once swelling dissipates. The surgeon should mention this to the client prior to the surgery. In therefore for these reasons my opinion on deviated nose correction surgery is the most difficult subdivision of rhinoplasty procedures. As well as there are always a risk of need for revision for a later time, however it is not needed as the patient will improve significantly than the previous condition.